[Two cases of renal oncocytoma]

Two cases of renal oncocytoma are reviewed. A 67-year-old man and a 21-year-old man with a right renal mass were incidentally revealed by echography. Selective renal angiogram showed no spoke-wheel configuration of vessels in either case. Both cases were pathologically diagnosed as oncocytomas, constructed of large eosinophilic cells with granular cytoplasm and small regular nuclei. The electron micrograph showed cytoplasm packed abundantly with mitochondria. The two patients are in good condition 2.5 and 1.5 years after diagnosis.

Aberrant cytokine production from tenosynovium in dialysis associated amyloidosis

Culture supernatants of tenosynovial tissues from patients with carpal tunnel syndrome undergoing chronic haemodialysis contained interleukin (IL) 1-like and IL6-like activity. These culture supernatants also induced active proliferation of rheumatoid synovial cells. Immunohistochemical analysis of teno-synovial tissues showed the accumulation of mononuclear cells bearing CD14 and HLA-DR antigens adjacent to the deposition of amyloid protein (beta 2 microglobulin). These cells also reacted with antibodies to IL1 and IL6 respectively. These data suggest that multiple cytokines, including IL1 and IL6, produced from tenosynovial tissues in patients with dialysis associated amyloidosis might induce the proliferation of synovial cells that, together with deposition of amyloid protein, might cause carpal tunnel syndrome.

Synthesis, structure and antitumor activity of a water-soluble platinum complex, (1R,3R,4R,5R)-(-)-quinato(1R,2R-cyclohexanediamine)platinum (II)

The reaction of dihydroxo(1R,2R-cyclohexanediamine)platinum(II) with (-)-quinic acid gave a water soluble complex, (-)-quinato(1R,2R-cyclohexanediamine)platinum(II). The crystal structure of the complex was determined by X-ray analysis. The data indicate a chelation of the alpha-hydroxycarboxylic acid part of quinic acid to platinum(II). The complex shows moderate antitumor activity against murine leukemia L1210 at high doses (T/C x 100 = 179% at a dose of 200 mg/kg).

Effects of several growth factors on cultured neurofibroma cells

Neurofibromatosis type 1 (NF1) is a common autosomal dominant disorder characterized by abnormalities affecting multiple tissues derived from the neural crest. The peripheral neurofibromas are numerous and sometimes reach several hundred in number. In this study, the possible involvement of several growth factors in neurofibroma growth was investigated in vitro. When explants of neurofibroma tissue were cultured, macrophage-like cells with pseudopodia migrated out first, and later took on a slender fusiform shape. These cells contained S-100 protein and were identified as Schwann cells. They did not proliferate under standard culture conditions. Nerve growth factor (NGF) was helpful in maintaining the differentiated phenotype of Schwann cells, but did not stimulate their proliferation. Immunohistochemical staining for type IV collagen revealed that some large flattened polygonal cells had a mesh of type IV collagen on the surface. These cells were perineurial cells. The proliferation of cells derived from neurofibroma was stimulated by basic fibroblast growth factor (bFGF), epidermal growth factor (EGF), and transforming growth factor alpha (TGF-alpha). In comparison with skin fibroblasts, the cells derived from neurofibroma responded to these growth factors at considerably lower concentrations. Stimulation by EGF at physiological concentrations indicated the possible involvement of EGF in the development of neurofibromas.

Clinical application of modified polyurethane graft to blood access

Based on a study of 34 clinical implantations, a porous poly(ether-urethane) graft developed for blood access was evaluated. Although it became clear that the graft has several advantages over expanded polytetrafluoroethylene (E-PTFE), it was also revealed that the occlusion at the anastomotic site was more frequently observed than that with E-PTFE. To improve the patency rate, a small modification of the luminal surface was attempted to give a better anchoring of the neointima. The results so far are better than those with the unmodified graft. However, the number of cases is small and the period of observation is short. More work will be necessary to confirm these preliminary results.

Binder's syndrome: peculiarities in Japanese patients

We have seen 4 Japanese patients with Binder's syndrome or maxillonasal dysostosis. The diagnosis of Binder's syndrome was very difficult, based on facial appearances alone. Although the flattened nasal tip was quite unusual in Japanese individuals, the midface retrusion and flattened nasal bridge would be considered within normal limits. Consequently, the diagnosis of Binder's syndrome is only rarely made in Japanese persons. The peculiarities of this syndrome in Japanese patients are discussed and our surgical methods are shown.

The relationship between juxtapapillary duodenal diverticula and the presence of bacteria in the bile

A total of 432 patients with gallstone disease were studied with respect to the existence of juxtapapillary duodenal diverticula and their relationship to the presence of bacteria in the bile. A total of 63 patients were found to have diverticula with an incidence of 14.6 per cent, being significantly higher in the elderly group aged 60 years or older (p less than 0.01), and no sex difference was noted. Among the patients with diverticula, positive bacterial cultures of bile were recognized at a significantly higher frequency, being found in 49 of the 63 patients (77.8 per cent; p less than 0.01), and the probability of bilirubinate stones was also higher, being found in 35 of 37 patients (94.6 per cent; p less than 0.01). The presence of a diverticulum bore significant relation to a higher positive bile bacterial culture (p less than 0.05), dilation of the common bile duct (p less than 0.05), and elevation of the bile duct pressure (p less than 0.05), even when the conditions were divided into cholecystolithiasis or choledocholithiasis. It was suggested that the presence of a diverticulum affected the flow in the bile duct by narrowing it from the outside and chronically stimulating the papilla, inducing biliary tract infection and/or the formation of gallstones. As the surgical procedures for juxtapapillary duodenal diverticula, including its indications, have not been established, long term follow up investigations seem necessary.

Kinetic study of glomerular cells of diabetic rats in relation to the development of irreversible glomerular sclerosis

In order to clarify the cellular kinetics involved in progression of diabetic glomerulosclerosis, the epithelial cells of spontaneously diabetic WBN/Kob rats were investigated by labeling with the DNA precursor bromodeoxyuridine, which was histochemically stained using monoclonal antibody. The labeling index (number of labeled cells/number of cells counted) of glomeruli was constantly low (approximately 0.15%) and no significant variation could be demonstrated in control rats of the Wistar strain. In both control and diabetic rats, podocytes showed no evidence of mitosis. In contrast to capillary podocytes, the Bowman epithelial cells of diabetic rats showed increased labeling, often surrounding sclerotic capillaries. These observations suggest a critical role of Bowman's epithelial cells in the development of irreversibly sclerotic glomeruli in diabetic nephropathy.

Suppression of proliferation of human epidermal keratinocytes by 1,25-dihydroxyvitamin D3. Analysis of its effect on psoriatic lesion and of its mechanism using human keratinocytes in culture

Psoriasis is a genetically determined chronic disease of the skin, and an accelerated proliferation of epidermal keratinocytes is one of the pathophysiological characteristics of psoriatic lesion. Recently, it was reported that topical administration of 1,25-dihydroxyvitamin D3 was effective for psoriasis. Our study was done to investigate the effect of 1,25-(OH)2-D3 on cell kinetics on human epidermal keratinocytes as a possible mechanism of its effect on psoriasis. After 24-h application of 1 microgram g-1 1,25-(OH)2-D3 ointment to psoriatic lesion, the number of mitotic keratinocytes decreased. When the cultured human keratinocytes were exposed to 10(-8) mol l-1 1,25-(OH)2-D3 for more than 9 days, inhibition of cell proliferation was noted. DNA distribution analysis by flow cytometry showed a decrease in cells in the S phase, and increase in 2c cells. This indicates blockade of the cell cycle in the G1 phase. The cell cycle time was not extended as a result of 1,25-(OH)2-D3-treatment.

Electron microscopic study of cultured cells from the murine hair tissues: cell growth and differentiation

The cultured hair cells from 4-day-old C3H mice were studied by electron microscopy. The hair roots isolated from the skin by collagenase digestion were dispersed into a cell suspension by treatment with a mixture of trypsin and ethylenediaminetetraacetate. The cells were cultured in MCDB-153 (a medium containing seven growth factors) for 1, 3, 6 or 13 days. The number of cultured cells on day 3 was twice that on day 1, and stayed at the same level until day 13. By electron microscopy, some of the cells cultured for 1 day were seen to be undifferentiated and others already showed differentiation into various hair structures. Such differentiated cells disappeared on day 3 and most of the cells cultured for 3 days were undifferentiated. Cell cultured for 6 days were differentiated showing inner root sheath cell, hair cortical cell and medulla cell structures. The characteristics of these cultured cells corresponded well to those of in vivo cells of the hair tissues from the back skin of 7-day-old C3H mice. On day 13 degeneration occurred in the cultured cells. In none of these cultures were mesenchymal cells, such as fibroblasts, found. The present electron microscopic study reveals that immature cells obtained from mouse hair tissues proliferate in vitro and differentiate into several subpopulations corresponding to those of in vivo cell layers of hair tissues. The present culture technique may be useful for studies of hair cell growth and differentiation.

Ciclosporin treatment in children with steroid-dependent nephrotic syndrome

We report our experience with ciclosporin (CS) treatment in 18 children with steroid-dependent nephrotic syndrome. CS was started at 3-5 mg/kg per day after the patients had attained remission with steroid therapy, and was adjusted to maintain a trough blood level of between 250 and 600 ng/ml, being administered for 6 months. Although 1 patient dropped out of the study because of renal dysfunction, the remaining 17 children completed the full trial. No relapse occurred during the 6-month period of CS treatment, and it was possible to discontinue steroid therapy in all patients. However, after discontinuation of CS treatment, nephrotic syndrome relapsed in 16 patients and 14 again had frequent relapses and became steroid-dependent, as before CS treatment. The effect of CS in maintaining remission from steroid-dependent nephrotic syndrome was thus dependent on continuation of CS treatment. Although several side-effects occurred during CS treatment, they were not so serious as to necessitate discontinuation of treatment, except in 1 patient, and all of these side effects were reversible. CS is therefore a new agent for the management of children with steroid-dependent nephrotic syndrome in place of corticosteroid and alkylating agents, although long-term maintenance therapy may be necessary for maintaining longer remission.

Organization and disorganization of actin filaments in human epidermal keratinocytes: heat-shock treatment and recovery process

We investigated alterations of actin organization due to heat shock and recovery from the collapse in human epidermal keratinocytes. Exposure of keratinocytes to elevated temperature caused the rapid disintegration of actin filaments. With a heat-shock treatment at 45 degrees C for 10 min, actin filaments disappeared and granular actin was distributed diffusely in the cytoplasm. After return to 37 degrees C, recovery of actin organization was observed. Completely disintegrated granular actin assembled to form actin dots, which tended to group. The grouping actin dots often took a circular, semicircular or arched form. Filamentous actin then extended out from the actin dots. Fine short bundles of actin filaments had a rippled appearance or were polygonal in structure, with actin filaments converged at many points. On the seventh day after heat-shock treatment, actin organization had almost returned to the pre-heat-shock condition, with diffusely distributed actin filaments. In previous studies, we observed such aberrant structures in human malignant keratinocytes and human epidermal keratinocytes treated with 12-O-tetradecanoylphorbol-13-acetate. The observations presented here indicate that those structures are not specific to malignancy or to the process of malignant transformation, but represent less mature and aberrant organizations of actin.

Immunoregulatory activity in human decidua

The immunoregulatory factor(s) that suppresses normal human peripheral blood mononuclear cells (PBM) function was extracted from the decidua of pregnant women (8-13 weeks). Compared with extracts from the proliferative endometrium, the decidual extracts from fresh surgical specimens markedly inhibited 3H-thymidine incorporation by PBM in response to T-cell mitogens. The majority of the lymphocyte-inhibitory activity was found to be associated with a material of large molecular weight in the decidua, as estimated by Sephadex G-200 filtration. Immunoelectrophoretic analysis followed by Sepharose 4B-anti-human IgG affinity chromatography of the fraction having the inhibitory activity revealed the causative factor to be most likely IgG or a substance copurified with IgG. The results are discussed with respect to a possible role of IgG in a localized non-specific suppressor mechanism in the decidua preventing maternal immunologic attack on the fetal allograft.

Difference in beta 2-microglobulin removal between cellulosic and synthetic polymer membrane dialyzers

Several kinds of dialyzers, with highly permeable membranes (HPM), have been designed to specifically remove beta 2-microglobulin (BMG). To clarify their solute transport characteristics, nine types of HPM dialyzers were evaluated during in vivo and in vitro studies using human plasma and aqueous solutions. No BMG membrane adsorption and/or plugging was seen with cellulosic membrane dialyzers during in vitro experiments using human plasma. On the other hand, all synthetic polymer membrane dialyzers had adsorptive properties, and in a dialyzer with a polymethylmethacrylate membrane, a large amount of BMG was removed by adsorption alone. Dialyzers with cellulose triacetate and polyacrylonitril membranes showed higher values of BMG diffusive dialysance (greater than 20 ml/min) and sieving coefficient (greater than 0.9). From in vitro experiments using an aqueous solution containing several solutes with relatively small or middle molecular weights, all HPM dialyzers had a higher overall mass transfer coefficient than any conventional membrane dialyzer.

[Measurement of the charge on red blood cells in patients with various glomerulopathies]

Red blood cells have a negative charge on their surface which prevents Rouloau formation. This charge may reflect the charge on glomerular capillaries. Using alcian blue, we measured the negative charge on red blood cells in patients with IgA nephropathy (IgAN), membranous nephropathy (MN), minimal change nephropathy (MCN) and focal glomerular sclerosis (FGS), for which the diagnosis was determined by renal biopsy. The alcian blue values for the normal control, IgAN, MCN (nephrotic phase), MCN (remission) and MN were 155.3 +/- 12.3, 140.9 +/- 23.9, 101.7 +/- 18.4, 152.9 +/- 11.2 and 140.9 +/- 23.6 ng per 1 x 10(6) red blood cells, respectively. The charge was more significantly decreased in MCN during nephrotic phase than other renal diseases and the normal control. The charge in MCN was within the normal range on remission. When we studied the correlation between the charge on red blood cells and proteinuria during steroid therapy, the charge in MCN was found to increase with reduction of proteinuria, while there was no change in MN and FGS with reduction of proteinuria, i.e. it was usually within normal range. The reduced charge was associated with the nephrotic phase in MCN. The difference in the charge on the red blood cells between MCN and FGS during nephrotic phase seems to suggest a different etiology of proteinuria. Measurement of the charge on red blood cells could be an useful method for differentiating MCN from other renal diseases in the nephrotic phase.

Growth of human keratinocytes in a defined medium supplemented with growth factor of serum

In order to prepare a good medium for cultivation of keratinocytes, bovine serum was fractionated by precipitation with various concentrations of ammonium sulfate. The fractionated serum proteins were added to the basal medium at a concentration of 3 mg/ml. The best proliferation was observed in the medium supplemented with the 55-70% ammonium sulfate precipitated fraction. No growth of keratinocytes was observed when the medium was supplemented with the 0-35% fraction. The growth promotion by the 55-70% fraction was completely inhibited by the 0-35% fraction. These results have shown that the fractionation of serum protein clearly separated the growth-inhibitory factors and the growth-stimulating factors.

Expression of proliferating cell nuclear antigen/cyclin in human keratinocytes

The expression of proliferating cell nuclear antigen (PCNA), also called cyclin, in human keratinocytes was examined by using the serum obtained from a SLE patient and a murine monoclonal antibody against PCNA/cyclin. In the normal epidermis, few of the nuclei were labeled with anti-PCNA/cyclin. This was in contrast to the positive nuclear staining seen in active lesions of psoriasis. In a primary culture of human keratinocytes growing as a monolayer, 20%-30% of cells expressed PCNA/cyclin. SV40-transformed human keratinocytes showed positive nuclear staining in about 40% of the cell population. In stratified keratinocytes cultured in a high Ca++ medium, PCNA/cyclin expression was decreased and only the cells in the basal and suprabasal layers showed positive staining. These results indicate that the expression of PCNA/cyclin correlates with the proliferating state in human keratinocytes and may not be associated with the mechanism of differentiation in keratinocytes.

Types of human papillomavirus isolated from Japanese patients with epidermodysplasia verruciformis

Virological studies were performed on 12 patients with epidermodysplasia verruciformis (EV). Three types of lesions were observed: red plaques, pityriasis versicolor (PV)-like macules and plane warts. Human papillomavirus (HPV) 14, 20 and 21 were isolated from the plaques, HPV 3, 14 and 38 from flat warts and HPV 5, 12, 17, 20 and 38 from PV-like lesions. No clear relationship could be established between the different lesions and the types of HPV. Types 17 and 20 have been isolated most frequently from Japanese EV patients and HPV 5, frequently detected in other countries, is less common, whereas HPV 8 has not been isolated. Skin cancers occurred in six of the cases (50%) and all had benign lesions that were PV-like. At least one type of HPV 5, 17 or 20 could be isolated from these benign lesions and HPV 17 or 20 detected in the cancers. These three types of HPV in EV patients appear to be involved in the malignant transformation.

[Methods for optimized cultivation of hair cells from C3H mice]

Methods for the optimized culturing the hair cells from 4-day-old C3H mice are described. The skin was obtained and soaked in 500 unit/ml dispase at 4 degrees C for 24 hr. Then the epidermis was removed and the dermis was further treated with 0.25% collagenase for 1 hr at 37 degrees C. The hair roots isolated by collagenase digestion of the dermis were dispersed by the treatment with the mixture of trypsin and EDTA into a cell suspension and plated on a substrate. Attachment of hair cells was dependent on serum concentrations and enhanced by collagen coating of the surface of dishes. MCDB 153 was beneficial for the growth of hair cells and discouraged for the growth of dermal fibroblasts. The cells could not grow at inoculum size of less than 3 x 10(4) cells/cm2. Addition of a crude bovine pituitary extract in MCDB 153 had the greatest impact on hair cell growth. Functional integrity of the cultured hair cells were maintained, since the hair-specific cytoskeletal proteins were expressed in these cells under the present experimental conditions. These desirable conditions could allow selective growth of the hair cells and provide the model system which could be used for the study of hair growth.

[A case of dumb-bell-like neurilemmoma of the posterior mediastinum]

A 56 year-old female was pointed out an abnormal shadow on chest X-ray film for the lung cancer screening study. Chest X-ray film showed a round mass shadow at the right superior mediastinum. Chest CT scan revealed the mass was in the paravertebral area abutting on the 2nd thoracic vertebral body and had extended into the intervertebral foramen. Preoperative diagnosis was a dumb-bell-like neurogenic tumor. Operation was carried out by posterior approach in the prone position. At first thoracotomy was done by removing the paravertebral portion of the 2nd and 3rd ribs, and then hemilaminectomy was added. Both the intrathoracic and intraforminal portions of the tumor were completely exposed, and excised. Pathological examination demonstrated the tumor was a typical neurilemmoma originating from the 2nd intercostal nerve. When a neurogenic tumor of the posterior mediastinum has an intraspinal extension, a posterior approach by a simultaneous thoracotomy and laminectomy will be useful to remove the tumor at one sitting.